BACKGROUND: Cryptococcosis occurring ≤30 days after transplantation is an unusual
event, and its characteristics are not known. METHODS: Patients included 175 solid-organ
transplant (SOT) recipients with cryptococcosis in a multicenter cohort. Very early-onset
and late-onset cryptococcosis were defined as disease occurring ≤30 days or >30 days
after transplantation, respectively. RESULTS: Very early-onset disease developed in
9 (5%) of the 175 patients at a mean of 5.7 days after transplantation. Overall, 55.6%
(5 of 9) of the patients with very early-onset disease versus 25.9% (43 of 166) of
the patients with late-onset disease were liver transplant recipients (P = .05). Very
early cases were more likely to present with disease at unusual locations, including
transplanted allograft and surgical fossa/site infections (55.6% vs 7.2%; P < .001).
Two very early cases with onset on day 1 after transplantation (in a liver transplant
recipient with Cryptococcus isolated from the lung and a heart transplant recipient
with fungemia) likely were the result of undetected pretransplant disease. An additional
5 cases involving the allograft or surgical sites were likely the result of donor&#x2010;acquired
infection. CONCLUSIONS: A subset of SOT recipients with cryptococcosis present very
early after transplantation with disease that appears to occur preferentially in liver
transplant recipients and involves unusual sites, such as the transplanted organ or
the surgical site. These patients may have unrecognized pretransplant or donor-derived
cryptococcosis.